Wiki Radial Digital Nerve Repair 64831 vs 64834

SavCoder

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Hey my coding family! I need some help with the difference between CPT 64831 and 64834. The description of the codes sound straight forward but this op note is making me second guess myself as to what the correct code is.



PREOPERATIVE DIAGNOSES:
1. Right index finger radial digital nerve laceration (zone 2 proximal to the proximal
interphalangeal joint).

POSTOPERATIVE DIAGNOSES:
1. Right index finger radial digital nerve laceration (zone 2 proximal to the proximal
interphalangeal joint).

OPERATION:
1. Right index finger radial digital nerve repair.

INDICATIONS: The patient is a 35-year-old female who complains of right index finger
numbness after sustaining a laceration to the right index finger one week ago. The
patient cut her right index finger on a broken piece of glass which was sutured at a local
Urgent Care. She notes numbness at the right index finger radial side of the digit
proximal to the distal interphalangeal joint. The laceration is present with sutures
noted. She has normal sensation at the ulnar side of the index finger and normal function
at the FDS and FDP as well as extensor tendon.

DESCRIPTION OF OPERATION:
The right upper extremity was
elevated, exsanguinated, and tourniquet inflated to 250 mmHg. The 3 cm oblique laceration
over the radial aspect of the right index finger extending from the PIPJ to the DIPJ was
identified. Sutures were removed. The laceration site was opened with tenotomy scissors
and explored. The transected digital nerve was identified. The proximal end of the
lacerated digital nerve was debrided sharply with a scalpel. Under loupe magnification,
an epineural repair was performed using 7-0 Prolene interrupted sutures for a total of 4
sutures. The radial digital artery was intact. The nerve repair was completed and
evaluated and noted to not be under stress in either flexion or extension. The wound was
irrigated with normal saline containing gentamicin. The skin incision was closed with 4-0
nylon interrupted sutures. The surgical site was dressed with Xeroform, sterile 4x4s and
Coban. A sterile splint was subsequently placed on the index finger. The tourniquet was
deflated for a total tourniquet time of 34 minutes.


The provider is suggesting CPT 64834 but I'm leaning towards CPT 64831 because the nerve repaired is the radial digital nerve in the index finger. Can the radial digital nerve be a sensory nerve? In the indications section, the patient was experiencing numbness. Would the symptom of numbness warrant billing the common sensory nerve repair CPT 64834 instead of the digital nerve repair CPT 64831?

Any insight would be greatly appreciated!
 
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